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Am J Emerg Med. 2017 Jan;35(1):13-19. doi: 10.1016/j.ajem.2016.09.027. Epub 2016 Sep 22.

Introduction of a pan-scan protocol for blunt trauma activations: what are the consequences?

Author information

1
Department of Surgery, Jamaica Hospital Medical Center, Jamaica, NY. Electronic address: mjames3@jhmc.org.
2
Department of Surgery, Jamaica Hospital Medical Center, Jamaica, NY; Department of Surgery, University of California at Irvine Medical Center, Orange, CA. Electronic address: sschubl@gmail.com.
3
Ross University, School of Medicine, Dominica, WI. Electronic address: mikefrancois3@gmail.com.
4
Department of Surgery, Jamaica Hospital Medical Center, Jamaica, NY; Department of Emergency Medicine, Jamaica Hospital Medical Center, Jamaica, NY. Electronic address: gdoughli@jhmc.org.
5
Department of Emergency Medicine, Jamaica Hospital Medical Center, Jamaica, NY. Electronic address: slee@jhmc.org.

Abstract

STUDY OBJECTIVE:

The aim of this study is to determine if the introduction of a pan-scan protocol during the initial assessment for blunt trauma activations would affect missed injuries, incidental findings, treatment times, radiation exposure, and cost.

METHODS:

A 6-month prospective study was performed on patients with blunt trauma at a level 1 trauma center. During the last 3 months of the study, a pan-scan protocol was introduced to the trauma assessment. Categorical data were analyzed by Fisher exact test and continuous data were analyzed by Mann-Whitney nonparametric test.

RESULTS:

There were a total of 220 patients in the pre-pan-scan period and 206 patients during the pan-scan period. There was no significant difference in injury severity or mortality between the groups. Introduction of the pan-scan protocol substantially reduced the incidence of missed injuries from 3.2% to 0.5%, the length of stay in the emergency department by 68.2 minutes (95% confidence interval [CI], -134.4 to -2.1), and the mean time to the first operating room visit by 1465 minutes (95% CI, -2519 to -411). In contrast, fixed computed tomographic scan cost increased by $48.1 (95% CI, 32-64.1) per patient; however, total radiology cost per patient decreased by $50 (95% CI, -271.1 to 171.4). In addition, the rate of incidental findings increased by 14.4% and the average radiation exposure per patient was 8.2 mSv (95% CI, 5.0-11.3) greater during the pan-scan period.

CONCLUSION:

Although there are advantages to whole-body computed tomography, elucidation of the appropriate blunt trauma patient population is warranted when implementing a pan-scan protocol.

PMID:
27773351
DOI:
10.1016/j.ajem.2016.09.027
[Indexed for MEDLINE]

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